The Indian government has moved to reduce the price of cancer drugs after a retired bank clerk took her case to the supreme court.
From next month, 137 cancer drugs in India will be cheaper as the government tries to tackle the tragedy of poorer patients either forgoing treatment, selling land or falling into debt to meet the high cost of some medicines, which are making large profits for hospitals and pharmacists.
Sarojam Radhakrishnan, a former bank employee in Kerala, was diagnosed with breast cancer in 2021. Doctors prescribed life-saving targeted treatments but the monthly cost, of more than 63,000 rupees (£500), was far beyond her family’s means.
Realising that thousands of families were being ruined by the cost of such drugs, Radhakrishnan filed a petition to the Kerala high court in 2022 demanding government intervention to lower the costs.
When the case reached the supreme court, the judges looked at hospitals’ and retailers’ mark-ups on cancer drugs and called the situation “carnage” and “extortion”.
During a hearing on 29 September, justices Vikram Nath and Sandeep Mehta noted how a life-saving cancer drug supplied to hospitals at 2,700 rupees carried a vastly marked-up price of 27,000 rupees .
The judges found that hospitals, distributors and chemists enjoyed large margins on medicines. Analysis by the National Pharmaceutical Pricing Authority revealed a trade mark-up on some cancer drugs averaging 170% , with some extreme examples stretching to more than 700%.
A 30% trade margin cap on the price of 42 drugs has been in place for some years but many others remained off this list. Now, prodded by the supreme court’s findings, the government has imposed the cap on 137 other drugs.
“The measure is expected to reduce medicine prices by up to 70% and help cancer patients save 2,500 crore rupees [£199m] annually, significantly reducing the amount they pay from their own pockets,” a statement from the Department of Pharmaceuticals said.
People on low incomes in India dread illness, as the cost of treatment can mean financial ruin, particularly for cancer patients.
Whenever the Indian Cancer Society holds a free diagnosis camp in Gurgaon where he lives, Krishan Kalra urges local drivers, maids, cooks and tailors to turn up because tests they cannot afford are offered free.
As a former member of the council of the Rajiv Gandhi Cancer Institute and Research Centre, Kalra knows the importance of early diagnosis, but he said very few people attended. “When I ask why, they say they’re too scared – if something serious like cancer is detected, they haven’t got the money to pay for the treatment so they prefer to remain in the dark,” he said.
With the cost of cancer drugs ranging in price from 38,000 to 380,000 rupees, many families quietly walk out of the doctor’s consulting room upon hearing the estimated cost of treatment.
Studies by the Public Health Foundation of India show that spending on healthcare pushes about 55 million Indians a year below the poverty line .
Few Indians can afford the premiums for comprehensive health insurance. The government’s nationwide insurance scheme, Ayushman Bharat, covers treatment for some cancers but it provides only 500,000 rupees’ worth of annual cover for a family – the cost of just one dose of Kadcyla (ado-trastuzumab emtansine), a drug used to treat breast cancer. Patients may need up to 14 doses.
Dr Ravi Kannan is a surgical oncologist and director of Cachar cancer hospital and research centre in Silchar, Assam. He has worked in hospitals elsewhere in India and is familiar with doctors’ trauma of seeing patients walk out to go home and die.
“Some families start the treatment, hoping against hope to manage the cost. They start but they don’t come back for chemotherapy or radiation. They can’t sustain the cost,” he said. “The decision is a welcome step if the outcome is that more patients can access the drugs they need.”
India records about 1.56m new cancer cases annually – up from 1.39m cases in 2020 – making it a significant public health challenge.
As the supreme court delves deeper into the subject, what was clear, said Jyotsna Singh, co-convener of the Working Group on Access to Medicines and Treatments, a civil society network, was that a “total overhaul” of the healthcare system was needed.
“Right from the cost of manufacturing a drug to the point of sale, we need to make the system transparent and regulate the entire supply chain. Only then will these drugs become available to those who need them,” she said.
Singh said companies and hospitals were likely to try to find legal loopholes to wriggle out of the 30% cap, suggesting that hospitals may offset the lower price charged for a drug by raising charges on other items.
The supreme court judges have also asked the government’s lawyers why the cap should apply only to cancer drugs and not the entire range of non-patented drugs. The court has given the government until 27 October to respond.
Unfortunately, the court’s ruling came too late for Radhakrishnan, who died in September 2022 while her case was still pending in Kerala.
